The impact of marital status on tumor aggressiveness, treatment, and screening among black and white men diagnosed with prostate cancer.

PURPOSE: To examine the association of marital status with prostate cancer outcomes in a racially-diverse cohort. METHODS: The study population consisted of men (1010 Black; 1070 White) with incident prostate cancer from the baseline North Carolina-Louisiana Prostate Cancer (PCaP) cohort. Marital status at time of diagnosis and screening history were determined by self-report. The binary measure of marital status was defined as married (including living as married) vs. not married (never married, divorced/separated, or widowed). High-aggressive tumors were defined using a composite measure of PSA, Gleason Score, and stage. Definitive treatment was defined as receipt of radical prostatectomy or radiation. Multivariable logistic regression was used to examine the association of marital status with (1) high-aggressive tumors, (2) receipt of definitive treatment, and (3) screening history among Black and White men with prostate cancer. RESULTS: Black men were less likely to be married than White men (68.1% vs. 83.6%). Not being married (vs. married) was associated with increased odds of high-aggressive tumors in the overall study population (adjusted Odds Ratio (aOR): 1.56; 95% Confidence Interval (CI): 1.20-2.02) and both Black and White men in race-stratified analyses. Unmarried men were less likely to receive definitive treatment in the overall study population (aOR: 0.68; 95% CI: 0.54-0.85). In race-stratified analyses, unmarried Black men were less likely to receive definitive treatment. Both unmarried Black and White men were less likely to have a history of prostate cancer screening than married men. CONCLUSION: Lower rates of marriage among Black men might signal decreased support for treatment decision-making, symptom management, and caregiver support which could potentially contribute to prostate cancer disparities.

An Invitation to Imagine: Conclusion of the HPP Series "What Is Anti-Racism in Health Promotion Practice?"

Throughout Volume 24 (2023) of Health Promotion Practice, we presented responses to our Call for content addressing the question, "What is Anti-Racism in Health Promotion Practice?" With Editorial Board colleagues, Aditi Srivastav Bussells and Carlos Rodríguez-Diaz, we (Keon L. Gilbert and Kathleen M. Roe) sought frameworks for action and practical examples that would catalyze, support, and (re)invigorate the field in response to the urgent need to eliminate racism as a cause of inequalities in health. This conversation with artist Wriply Bennett concludes the series. We invite scholars and practitioners to review all 17 contributions to the series and to continue to ask - and address - the question 'What is anti-racism in our practice, scholarship, and lives?"

Promoting Health Equity Through the Power of Place, Perspective, and Partnership.

The 10 articles in the Preventing Chronic Disease (PCD) special collection on health equity highlight that a commitment to self-reflection, cultural humility, and lifelong learning are foundations of health equity science and that the field is interdependent with the perspectives and context of communities.Three themes - place, perspective, and partnership - emerged from the PCD special collection. The articles embody the principles outlined in the Healthy People definition of health equity and CDC's CORE Health Equity Science and Intervention Strategy. They highlight the critical role that context, qualitative methods, and community-based participatory research play in efforts to achieve health equity. However, the science of achieving health equity is rooted in antiracism principles; the "inner work" of learning, unlearning, relearning, and co-learning; and the efforts to equip communities to act, research, and intervene for themselves. Without these added critical structural lenses, health equity science will continue to fail to achieve its goal.

Racial Discrimination of Adolescents With Special Healthcare Needs.

PURPOSE: Examine racial discrimination of adolescents of color by type of special healthcare need (SHCN). METHODS: Pooled cross-sectional data of youth over 10 years of age from 2018 to 2020 National Surveys of Children's Health were used (n = 48,220). Rates of discrimination by SHCN diagnoses within racial and ethnic groups were examined. RESULTS: Adolescents of color with SHCNs were almost twice as likely to experience racial discrimination as peers of color without SHCNs. Asian youth with SHCNs were over 3.5 times likely to experience racial discrimination as peers without. Youth with depression experienced highest rates of racial discrimination. Compared to peers without, Black youth with asthma or a genetic disorder, and Hispanic youth with autism or intellectual disabilities, experienced higher rates of racial discrimination. DISCUSSION: SHCN status heightens racial discrimination for adolescents of color. However, this risk was not uniform by racial or ethnic group for every SHCN type.

Promoting Authentic Academic-Community Engagement to Advance Health Equity.

Meaningful community engagement is critical to achieving the lofty goal of health equity. Nonetheless, implementing the principles of community engagement is not easy. Attempting to implement best practices for collaborating on transdisciplinary teams and working with community partners can be challenging, particularly in locales that have a long history of strained university-community relationships. The purpose of this paper is to provide additional context and consideration for researchers, community partners, and institutions interested in conducting community-engaged research. Here, we provide guidance and highlight exemplary programs that offer effective approaches to enhance the strength of community partnerships. These partnerships not only hold promise but are also essential in the development of the local, multi-factor solutions required to address racial/ethnic inequities in health.

Say Something, Do Something: Evaluating a Forum Theater Production to Activate Youth Violence Prevention Strategies in Schools.

BACKGROUND: Youth violence that takes place within school settings exposes youth to serious social, mental and physical consequences that affect education performance, and life opportunities. Previous work shows positive youth development frameworks can promote social-emotional learning by enhancing empathy and building problem-solving and conflict management skills. Theater-based interventions have been shown to enhance social emotional development by privileging youth voices, and building youth capacities and strengths. The current manuscript presents the evaluation of an arts-based and public health framework conducted to assess the development, implementation and impact of a forum theater production, Say Something, Do Something (SSDS) in St. Louis, Missouri. METHODS: An iterative mixed methods approach was used, starting with observations of productions. Using convenience sampling, we then conducted post interviews of the theater team (n = 8) and school personnel (n = 10). RESULTS: Respondents highlighted that as a result of engagement of school personnel in program development, the language and scenarios presented were relevant to students. Data indicated that SSDS increased student knowledge and changed attitudes, developed student conflict management and problem-solving skills, and improved interpersonal behavior. SSDS also raised awareness of the importance of, and created the foundation for, additional system and policy changes in the schools. CONCLUSION AND IMPLICATIONS: Forum theater is an approach that can enhance socio-emotional learning and conflict management among youth. Collaborative initiatives between public health and the arts are poised to uniquely engage community partners, animate interventions, and impact critical public health issues including youth violence prevention.

Social Capital, Black Social Mobility, and Health Disparities.

This review aims to delineate the role of structural racism in the formation and accumulation of social capital and to describe how social capital is leveraged and used differently between Black and White people as a response to the conditions created by structural racism. We draw on critical race theory in public health praxis and restorative justice concepts to reimagine a race-conscious social capital agenda. We document how American capitalism has injured Black people and Black communities' unique construction of forms of social capital to combat systemic oppression. The article proposes an agenda that includes communal restoration that recognizes forms of social capital appreciated and deployed by Black people in the United States that can advance health equity and eliminate health disparities. Developing a race-conscious social capital framing that is inclusive of and guided by Black community members and academics is critical to the implementation of solutions that achieve racial and health equity and socioeconomic mobility.

(Im)Balancing Acts: Criminalization and De-Criminalization of Social and Public Health Problems.

Racially disparate policing, prosecution, and punishment harm individuals, families, and communities. These practices must be understood within the context of the development of the criminal legal system as a means of racialized social control. This context permits a critical examination of the way criminalization has been and is still deployed to subject poor and racialized communities to systemic injustices. This commentary frames a call for interventions to integrate a health justice approach to ensure that they advance racial and health equity to promote the well-being of individuals, families, and communities.

Correlates of COVID-19 Vaccine Hesitancy among a Community Sample of African Americans Living in the Southern United States.

In the United States, African Americans (AAs) have been disproportionately affected by COVID-19 mortality. However, AAs are more likely to be hesitant in receiving COVID-19 vaccinations when compared to non-Hispanic Whites. We examined factors associated with vaccine hesitancy among a predominant AA community sample. We performed a cross-sectional analysis on data collected from a convenience sample of 257 community-dwelling participants in the Central Savannah River Area from 5 December 2020, through 17 April 2021. Vaccine hesitancy was categorized as resistant, hesitant, and acceptant. We estimated relative odds of vaccine resistance and vaccine hesitancy using polytomous logistic regression models. Nearly one-third of the participants were either hesitant (n = 40, 15.6%) or resistant (n = 42, 16.3%) to receiving a COVID-19 vaccination. Vaccine-resistant participants were more likely to be younger and were more likely to have experienced housing insecurity due to COVID-19 when compared to both acceptant and hesitant participants, respectively. Age accounted for nearly 25% of the variation in vaccine resistance, with 21-fold increased odds (OR: 21.93, 95% CI: 8.97-5.26-91.43) of vaccine resistance in participants aged 18 to 29 compared to 50 and older adults. Housing insecurity accounted for 8% of the variation in vaccine resistance and was associated with 7-fold increased odds of vaccine resistance (AOR: 7.35, 95% CI: 1.99-27.10). In this sample, AAs under the age of 30 and those experiencing housing insecurity because of the COVID-19 pandemic were more likely to be resistant to receiving a free COVID-19 vaccination.

Physical health composite and risk of cancer mortality in the REasons for Geographic and Racial Differences in Stroke Study.

It is unclear how resting myocardial workload, as indexed by baseline measures of rate-pressure product (RPP) and physical activity (PA), is associated with the overall risk of cancer mortality. We performed prospective analyses among 28,810 men and women from the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. We used a novel physical health (PH) composite index and categorized participants into one of four groups based on combinations from self-reported PA and RPP: 1) No PA and High RPP; 2) No PA and Low RPP; 3) Yes PA and High RPP; and 4) Yes PA and Low RPP. We examined the association between baseline PH composite and cancer mortality adjusted for potential confounders using Cox regression. A total of 1191 cancer deaths were observed over the 10-year observation period, with the majority being lung (26.87%) and gastrointestinal (21.49%) cancers. Even after controlling for sociodemographics, health behaviors, baseline comorbidity score, and medications, participants with No PA and High RPP had 71% greater risk of cancer mortality when compared to participants with PA and Low RPP (adjusted HR: 1.71, 95% CI: 1.42-2.06). These associations persisted after examining BMI, smoking, income, and gender as effect modifiers and all-cause mortality as a competing risk. Poorer physical health composite, including the novel RPP metric, was associated with a nearly 2-fold long-term risk of cancer mortality. The physical health composite has important public health implications as it provides a measure of risk beyond traditional measure of obesity and physical activity.

How neighborhoods matter in fatal interactions between police and men of color.

This article addresses the concern that death by legal intervention is a health outcome disproportionately experienced by boys and men of color, and predicated on the quality of the locations in which encounters with law enforcement occur. Using a more comprehensive cross-verified sample of police homicides from online databases and a nationally representative sample of law enforcement agencies, this study examines whether neighborhood social disorganization, minority threat, and defense of inequality theories help explain the odds that males of color will have a fatal interaction with police (FIP). There are several noteworthy results. First, in support of the defense of inequality thesis, we found that income inequality within the area in which a FIP occurred is related to increased relative odds of fatal injury for males of color and Hispanic males. Second, consistent with the minority threat thesis, we found low levels of racial segregation dramatically reduced the odds of a FIP for Black males while higher levels of segregation increased the odds for Hispanic males. Third, Hispanic males were over 2.6 times as likely as others to be killed by officers from agencies with relatively higher percentages of Hispanic officers. We conclude the study with a discussion of its implications for research and policy.

Adaptation, Implementation, and Evaluation of a Public Health Research Methods Training for Youth.

Purpose: To adapt, implement, and evaluate a public health research methods training program for youth. The Community Research Fellows Training Program is an evidence-based public health research methods training program for adults (18 years and older). The Youth Research Fellows Training (YRFT) is an adaptation of this program for youth. Methods: University faculty facilitate didactic training sessions and experiential small group activities in biweekly sessions conducted as part of an existing 4-week summer camp. Participants were African American girls (n=11) ranging from ages 10 to 14 years (most recent grade completed 4th-8th). To evaluate participant knowledge gain and satisfaction pre-tests were administered before each session, and post-test and evaluations were administered after each session. In addition, faculty completed web-based evaluation surveys on their experience teaching in the program. Results: Mean and median post-test scores were higher than pre-test scores for most (6 of the 7) of the training sessions; one session had no difference in scores. Participants rated the sessions well, on average overall session ratings of 4.3-4.8 on a 5-point Likert scale. Faculty rated their experience teaching in the program as excellent or very good and would be willing to teach in the program again (n=7; 100%). Conclusion: This pilot implementation of the YRFT program proved highly successful in terms of participant and faculty experience. The program evaluation demonstrates increased knowledge of public health research methods. This program has the potential to prepare youth to engage in public health research as partners not just participants.

Missed Opportunity? Leveraging Mobile Technology to Reduce Racial Health Disparities.

Blacks and Latinos are less likely than whites to access health insurance and utilize health care. One way to overcome some of these racial barriers to health equity may be through advances in technology that allow people to access and utilize health care in innovative ways. Yet, little research has focused on whether the racial gap that exists for health care utilization also exists for accessing health information online and through mobile technologies. Using data from the Health Information National Trends Survey (HINTS), we examine racial differences in obtaining health information online via mobile devices. We find that blacks and Latinos are more likely to trust online newspapers to get health information than whites. Minorities who have access to a mobile device are more likely to rely on the Internet for health information in a time of strong need. Federally insured individuals who are connected to mobile devices have the highest probability of reliance on the Internet as a go-to source of health information. We conclude by discussing the importance of mobile technologies for health policy, particularly related to developing health literacy, improving health outcomes, and contributing to reducing health disparities by race and health insurance status.

African American prostate cancer survivorship: Exploring the role of social support in quality of life after radical prostatectomy.

PURPOSE: The aim of this study was to explore the African American prostate cancer survivorship experience following radical prostatectomy and factors contributing to quality of life during survival. DESIGN: African American men who were part of a larger prostate cancer cohort were invited to participate in a focus group. Eighteen open-ended questions were designed by the study team and an experienced moderator to elicit participants' survivorship experiences. RESULTS: Twelve men consented to participate in the study. Emergent themes included views of prostate cancer in the African American community, perceptions of normalcy, emotional side effects following radical prostatectomy, and social support involvement and impact during recovery. CONCLUSIONS: Previous findings suggest that African American men may experience more distress than Caucasian men when facing typical prostate cancer side effects. Traditional masculine role norms and negative perceptions of "disease disclosure" in the African American community could be contributing to the distress reported by some in this study. Strengthening social support systems by promoting more prosocial coping and help-seeking behaviors early in the survivorship journey may help bypass the detrimental health effects associated with masculine role identification, resulting in improved quality of life throughout the lengthy survival period anticipated for these men.

Physician role in physical activity for African-American males undergoing radical prostatectomy for prostate cancer.

PURPOSE: Physical activity is recognized as a complementary therapy to improve physical and physiological functions among prostate cancer survivors. Little is known about communication between health providers and African-American prostate cancer patients, a high risk population, regarding the health benefits of regular physical activity on their prognosis and recovery. This study explores African-American prostate cancer survivors' experiences with physical activity prescription from their physicians. METHODS: Three focus group interviews were conducted with 12 African-American prostate cancer survivors in May 2014 in St. Louis, MO. Participants' ages ranged from 49 to 79 years, had completed radical prostatectomy, and their time out of surgery varied from 7 to 31 months. RESULTS: Emerged themes included physician role on prescribing physical activity, patients' perceived barriers to engaging in physical activity, perception of normalcy following surgery, and specific resources survivors' sought during treatment. Of the 12 men who participated, 8 men (67%) expressed that their physicians did not recommend physical activity for them. Although some participants revealed they were aware of the importance of sustained physical activity on their prognosis and recovery, some expressed concerns that urinary dysfunction, incontinence, and family commitments prevented them from engaging in active lifestyles. CONCLUSIONS: Transitioning from post radical prostatectomy treatment to normal life was an important concern to survivors. These findings highlight the importance of physical activity communication and prescription for prostate cancer patients.

Descriptive Analysis of the 2014 Race-Based Healthcare Disparities Measurement Literature.

IMPORTANCE: There are more than 500 articles in the 2014 race-based healthcare disparities literature across a broad array of diseases and outcomes. However, unlike many other forms of research (e.g., clinical trials and systematic reviews), there are no required reporting guidelines when submitting results of disparities studies to journals. OBJECTIVE: This study describes the race-based healthcare disparities measurement literature in terms of study design, journal characteristics, generation of health disparities research, type of disparity measure used, and adherence to disparities measurement guidelines. METHODS: We searched three databases of peer-reviewed literature, PubMed, Ovid Medline, and JSTOR, for English language articles published in 2014 on racial/ethnic healthcare disparities. Studies must have quantitatively measured the difference in health outcomes between two racial/ethnic groups in order to be included. Our final sample included 266 studies from 167 medical and public health journals. FINDINGS: Only 7 % (n = 19) of articles reported both an absolute and relative measure of disparity; the majority of studies (64 %, n = 171) reported only a relative measure of effect. Most studies were published in clinical journals (74 %, n = 198), used secondary data (86 %, n = 229), and calculated black-white disparities (82 %, n = 218). The most common condition studied was cancer (25 %, n = 67), followed by a surgical procedure (18 %, n = 48). On average, articles in the sample only met 61 % of the applicable guidelines on reporting of disparities. CONCLUSIONS AND RELEVANCE: To be able to synthesize findings in the racial disparities literature (meta-analysis), there is a need for the use of consistent methods for quantifying disparities and reporting in the literature. A more consistent battery of measures and consistent reporting across studies may help speed our understanding of the origins and development of solutions to address healthcare disparities. Despite guidelines for best practices in reporting disparities, there is a lack of adherence in the current literature.